Example of a non-weight-based intravenous heparin protocol: Titration based upon the activated partial thromboplastin time (aPTT)

IV infusion
aPTT	Rate change, mL/hour*	Dose change, units/24-hour	Additional action
≤45	+6	+5760	Repeated aPTT^¶ in 4 to 6 hours
46 to 54	+3	+2880	Repeated aPTT in 4 to 6 hours
55 to 85	0	0	None^Δ
86 to 110	–3	–2880	Stop heparin sodium treatment for 1 hour; repeated aPTT 4 to 6 hours after restarting heparin treatment
>110	–6	–5760	Stop heparin treatment for 1 hour; repeated aPTT 4 to 6 hours after restarting heparin treatment

NOTE: This table reflects the original aPTT ranges, bolus sizes, and suggested changes in infusion rate that were present at the time this study was performed. The therapeutic ranges (ie, relationship between the aPTT and anti-factor Xa activity), initial and subsequent bolus sizes, and sizes of the infusion rate changes, as well as dosing differences depending on the disorder under treatment (eg, venous thromboembolism, stroke, acute coronary syndrome) should be established separately for each institution.

aPTT: activated partial thromboplastin time; IV: intravenous.
* Heparin sodium concentration, 20,000 units in 500 mL = 40 units/mL.
¶ With the use of Actin-FS thromboplastin reagent (Dade, Mississauga, Ontario).
Δ During the first 24 hours, repeated aPTT in 4 to 6 hours. Thereafter, the aPTT will be determined once daily, unless subtherapeutic.

Redrawn from: Hull RD, Raskob GE, Rosenbloom D, et al. Optimal therapeutic level of heparin therapy in patients with venous thrombosis. Arch Intern Med 1992; 152:1589.

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Example of a non-weight-based intravenous heparin protocol: Titration based upon the activated partial thromboplastin time (aPTT)